定量脑电图在血管性认知障碍中的应用
作者:
作者单位:

1.河北北方学院研究生院,河北 张家口 075000;2.河北省人民医院神经内一科/河北省脑网络与认知损害疾病重点实验室,河北 石家庄 050051

作者简介:

顾羽萱(1998―),女,医学硕士,主要从事脑血管病认知障碍的临床和基础研究。

通信作者:

肖向建(1973—),男,主任医师,研究生导师,医学博士,主要从事脑血管病认知障碍的临床和基础研究。Email:xiaoxiangjian@aliyun.com。

基金项目:

2023年度河北省医学科学研究课题计划(20230292)。


Application of quantitative electroencephalography in vascular cognitive impairment
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Affiliation:

1.Graduate School, Hebei North University, Zhangjiakou, Hebei 075000, China;2.First Department of Neurology, Hebei General Hospital / Hebei Key Laboratory of Brain Networks and Cognitive Impairment Diseases, Shijiazhuang, Hebei 050051, China

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    摘要:

    血管性认知障碍(vascular cognitive impairment, VCI)是指由脑血管病危险因素引起,包含从轻度认知障碍到痴呆的一大类综合征,其临床表现形式多样,早期具有隐匿性。临床广泛应用神经心理学量表(如蒙特利尔认知评估量表、简易精神状态检查量表等)作为评估VCI的证据,但存在特异性及敏感性较低、主观性偏差等局限。定量脑电图(quantitative electroencephalography, QEEG)是近年来应用于临床的一种新技术,以其无创、可量化、实时监控的特点被研究者所重视。越来越多的证据表明,QEEG特异性量化指标对VCI的早期诊断有所帮助。目前,常用的QEEG量化指标主要包括相对功率值、慢波化比率、成对衍生脑对称指数、EEG相干系数、Lemple-Ziv复杂度、P300等。轻度认知障碍是VCI的早期阶段,轻度认知障碍患者QEEG特异性改变主要以慢波功率和θ波与β波比值升高、P300潜伏期延长及波幅减低等为主要特点。脑小血管病是VCI常见的亚型之一,临床症状隐匿且进程缓慢,常容易被患者及医务人员忽视。其相关电生理研究报道相对较少,目前认为EEG背景变化的同时出现大量异常尖波可提示脑小血管病认知障碍加重。卒中后认知障碍是由卒中事件触发的VCI。有研究发现,δ波、θ波、β波、δ波与α波比值R和δ波与θ波比值均对识别卒中后认知障碍有一定的意义。此外,应用QEEG技术还可准确地将VCI与其他认知障碍(如路易体痴呆、阿尔茨海默病等)进行鉴别,也可用于药物或其他干预措施对VCI患者治疗前后的疗效评价。因此,QEEG分析技术作为新的一种补充或替代性手段,为追踪VCI的进展轨迹、鉴别各种认知障碍和协助制定治疗方案提供了全新的方向和思路。

    Abstract:

    Vascular cognitive impairment (VCI) refers to a broad category of syndromes caused by the risk factors for cerebrovascular diseases, ranging from mild cognitive impairment to dementia, and it has diverse clinical manifestations, often with occult early signs. Neurocognitive scales that are widely used in clinical practice, such as Montreal Cognitive Assessment and Mini-Mental State Examination, are used as the evidence for evaluating VCI; however, their application is limited due to low specificity, low sensitivity, and subjective bias. As a new technique used in clinical practice in recent years, quantitative electroencephalography (QEEG) has been taken seriously by researchers due to its features of noninvasiveness, quantifiability, and real-time monitoring. Currently, an increasing amount of evidence has shown that the specific quantitative parameters of QEEG can help with the early diagnosis of VCI, and the commonly used parameters include relative power, slow wave ratio, paired derived brain symmetry index, EEG coherence, Lemple-Ziv complexity, and P300. Mild cognitive impairment (MCI) is the early stage of VCI, and the specific changes on QEEG for MCI patients mainly include increased slow wave power and θ waves and β waves ratio value, prolonged P300 latency, and reduced wave amplitude. Cerebral small vessel disease (CSVD) is one of the common subtypes of VCI and has occult clinical symptoms and slow progression, and thus it is often neglected by patients and medical staff. There are relatively few reports on related electrophysiological research, and it is currently believed that the simultaneous appearance of a large number of abnormal sharp waves and background changes on electroencephalography may indicate the exacerbation of cognitive impairment in CSVD. Post-stroke cognitive impairment (PSCI) refers to cognitive impairment triggered by stroke events, and studies have shown that δ waves, θ waves, β waves, δ waves and αwaves ratio value, and δ waves and θ waves ratio value, all have a certain significance in identifying PSCI. Furthermore, the application of QEEG technique can accurately differentiate VCI from other cognitive impairment disorders, such as dementia with Lewy bodies and Alzheimer's disease, and it can also be used to evaluate the efficacy of drug or other intervention measures in VCI patients. Therefore, as a new supplementary or alternative method, QEEG technique provides new directions and ideas for tracking the progression of VCI, distinguishing various cognitive impairments, and assisting in the development of treatment plans.

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顾羽萱,赵明敏,高紫谊,张阳,肖向建456.定量脑电图在血管性认知障碍中的应用[J].国际神经病学神经外科学杂志,2023,50(5):84-88111GU Yuxuan, ZHAO Mingmin, GAO Ziyi, ZHANG Yang, XIAO Xiangjian222. Application of quantitative electroencephalography in vascular cognitive impairment[J]. Journal of International Neurology and Neurosurgery,2023,50(5):84-88

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  • 收稿日期:2022-11-20
  • 最后修改日期:2023-07-23
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  • 在线发布日期: 2023-11-30
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